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Rate Review and Rate Guides

The managed care regulation requires that states develop valid managed care capitation rates in accordance with generally accepted actuarial principles and practices.

2020-2021 Medicaid Managed Care Rate Development Guide

CMS is releasing the 2020-2021 Medicaid Managed Care Rate Development Guide (PDF, 410.07 KB) for states to use when setting rates with respect to any managed care program subject to federal actuarial soundness requirements during rating periods starting between July 1, 2020 and June 30, 2021. The guide provides detail around CMS' expectations of information to be included in actuarial rate certifications, and the guide will be used as a basis for CMS’ review. Consistent with the letter from the Administrator on March 14, 2017, and the Informational Bulletin (PDF, 58.46 KB) released on June 30, 2017, CMS engaged in a comprehensive review of the managed care rules to prioritize beneficiary outcomes and more effective program management, culminating in release of a Notice of Proposed Rulemaking in November 2018. Pending adoption of a final rule amending them, the regulations currently in place continue to govern the rate-setting practices for Medicaid managed care plans that are outlined in this guide. Please direct any questions related to this guide to MMCratesetting@cms.hhs.gov.

View previous years’ rate-setting guidance: